Provider Demographics
NPI:1093727083
Name:CHOICE CITY DRUG, INC
Entity Type:Organization
Organization Name:CHOICE CITY DRUG, INC
Other - Org Name:CITY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BERNHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:BSCHEM,BSPHARM,BOC,
Authorized Official - Phone:970-482-1234
Mailing Address - Street 1:209 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2808
Mailing Address - Country:US
Mailing Address - Phone:970-482-1234
Mailing Address - Fax:970-482-2412
Practice Address - Street 1:209 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2808
Practice Address - Country:US
Practice Address - Phone:970-482-1234
Practice Address - Fax:970-482-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO440000004332B00000X, 332BC3200X, 332BN1400X, 332BP3500X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0611776OtherNABP
CO03001328Medicaid
CO0611776OtherNABP